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China
Information
Health in
China |
Source: World Health Organization
China has nearly a quarter of the world population; dramatic economic,
social and political changes in
recent years have had major impacts on health and health care. Disease
burden has largely shifted from
communicable to noncommunicable diseases and injuries. An unprecedented
demographic transition is in
progress with decreasing birth rates and an increasingly elderly
population which will create new challenges
and involve extensive restructuring of the health system.
Market reforms and economic liberalization of the 1980s resulted in a
period of rapid economic growth
(with annual growth rates averaging 8-9% since 1978); however social
and human development has not
kept pace with economic growth. Industrial expansion and rising incomes
have accelerated migration from
rural areas to urban centers.
Rapid economic growth has not been reflected in increased government
investment in
health. Health insurance coverage at the end of 2005 was approximately
40% - including the urban basic
health insurance scheme, new rural cooperative medical scheme and other
health insurances; out-of pocket
payments constitute the majority of growing health expenditures (54%).
China has a complex health
financing system decentralized to the lowest administrative level;
there is widespread reliance on service
fees and long-standing underinvestment in public health services
resulting in huge inequalities between
eastern and western China, rich and poor and urban and rural
populations. China faces major challenges to
achieving the United Nations (UN) Millennium Development Goals (MDGs)
on HIV/AIDS, gender and
environmental sustainability. Targets on improving child and maternal
health may be met if access to health
can be improved.
More than 12 ministries or agencies administer health in China
including the Ministry of Health (MoH),
Ministry of Labor and Social Security and the National Development and
Reform Commission.
Communicable diseases and malnutrition have major impact on health,
especially in
less developed areas, and particularly among young children. Lower
respiratory infections, hepatitis B
and tuberculosis cause significant mortality and morbidity;
approximately 10% of the population are
chronic carriers of hepatitis B, causing an estimated 70% of all cases
of liver cancer in China. The
emergence of severe acute respiratory syndrome (SARS) in southern China
in 2003 demonstrated the
importance of general strengthening of public health, including
surveillance, hospital infection control and
health information systems.
Infant and under-five mortality rates remain high where access to
services is low,
particularly due to communicable diseases and perinatal conditions.
Despite overall improvements in child
mortality, inequalities persist with higher rates in western China and
in rural areas.
Noncommunicable diseases and injuries account for over 80% of deaths.b
Leading causes
of death in China include cerebrovascular disease (including stroke),
heart disease and cancer (accounting
for approximately more than 50% of all deaths). Road-traffic injuries,
depression and suicide are also
leading causes of mortality and morbidity, especially in the young and
economically active age groups.
Smoking is widespread; China is the world's largest producer and
consumer of cigarettes with over 1800
billion cigarettes sold each year.c There are 320 million smokers in
China (30% of the total number of
smokers globally) and the country accounts for approximately 30% of the
global production of tobacco
products.
a
Third National Health Services Survey, reports from the insurance
schemes of the Ministry of Health and the Ministry of Labor and Social
Security
b
Global Programme for Evidence in Health Policy, WHO.
c
World Bank. Economic Analysis of
Tobacco and Options for Tobacco Control: China Case Study. HNP
Discussion Paper. 2002.
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Health:
Indicators of the status of China’s health sector can be found in the
nation’s fertility rate of 1.8 children per woman (a 2005 estimate) and
an under-five-years-of-age mortality rate of 37 per 1,000 live births
(a 2003 estimate). In 2002 China had nearly 1.7 physicians per 1,000
persons and about 2.4 beds per 1,000 persons in 2000. Health
expenditures on a purchasing parity power (PPP) basis were US$224 per
capita in 2001, or 5.5 percent of gross domestic product (GDP). Some
37.2 percent of public expenditures were devoted to health care in
China in 2001. However, about 80 percent of the health and medical care
services are concentrated in cities, and timely medical care is not
available to more than 100 million people in rural areas. To offset
this imbalance, in 2005 China set out a five-year plan to invest 20
billion renminbi (RMB; US$2.4 billion) to rebuild the rural medical
service system composed of village clinics and township- and
county-level hospitals.
In 2004 health officials announced that
China had some 120 million hepatitis B virus carriers. Although not
identified until later, China’s first case of a new, highly contagious
disease, severe acute respiratory syndrome (SARS), occurred in
Guangdong in November 2002, and within three months the Ministry of
Health reported 300 SARS cases and five deaths in the province. By May
2003, some 8,000 cases of SARS had been reported worldwide; about 66
percent of the cases and 349 deaths occurred in China alone. By early
summer 2003, the SARS epidemic had ceased. A vaccine was developed and
first-round testing on human volunteers completed in 2004.
China,
similar to other nations with migrant and socially mobile populations,
has experienced increased incidences of human immunodeficiency
virus/acquired immune deficiency syndrome (HIV/AIDS). Based on 2003
estimates, China is believed to have a 0.1 percent adult prevalence
rate for HIV/AIDS, one of the lowest rates in the world and especially
in Asia. However, because of China’s large population, this figure
converted in 2003 to some 840,000 cases (more than Russia but fewer
than the United States and second in Asia to India), of whom 44,000
died. About 80 percent of those infected live in rural areas. In
November 2004, the head of the United Nations AIDS program (UNAIDS)
cited China, along with India and Russia, as being on the “tipping
point” of having small, localized AIDS epidemics that could turn into
major ones capable of hindering the world’s efforts to stop the spread
of the disease.
In 2004 the Ministry of Health reported that
its annual AIDS prevention funding had increased from US$1.8 million in
2001 to US$47.1 by 2003 and that, whereas treatment had been restricted
to a few hospitals in major cities, treatment was becoming more widely
available. According to the study by the World Health Organization,
China’s Ministry of Health, and UNAIDS, China had an estimated 650,000
people who were infected with HIV by the end of 2005.
In the
2000–2002 period, China had one of the highest per capita caloric
intakes in Asia, second only to South Korea and higher than countries
such as Japan, Malaysia, and Indonesia. By 2002, 92 percent of the
urban population and 68 percent of the rural population had access to
an improved water supply, and 69 percent of the urban population and 29
percent of the rural population had access to improved sanitation
facilities.
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